AB0307 JAK INHIBITORS DO NOT WORSEN RA-ILD; COMPARISON OF CHANGES IN CT IMAGES AND KL-6/SP-D LEVELS BETWEEN PERIODS WITH BIOLOGICS AND WITH JAK INHIBITORS IN THE SAME INDIVIDUALS
Authors: A. Tanaka, R. Koike, R. Sato, A. Kikuchi, S. Komatsu, A. Hasegawa, T. Hiyama, E. Fukasawa, T. Miyao, S. Arai, T. Owada, R. Maezawa, M. Arima, K. Kurasawa
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Interstitial lung disease (ILD) is a serious organ involvement that influences the prognosis of RA patients and limits RA therapy. The association between RA activity and ILD progression has been suggested. However, the effects of biologics (Bio) on ILD are controversial; several studies showed that Bio increased ILD-related death, whereas others reported that Bio stabled the progression of ILD. Moreover, the effects of JAK inhibitors (Jaki) on ILD are largely unknown. <h3>Objectives</h3> To clarify the effects of Jaki on RA-ILD by comparing the changes in CT images and KL-6/SP-D levels between periods with biologics and with JAK inhibitors in the same individuals. <h3>Methods</h3> Participants were consecutive RA patients who received Jaki from June 2014 to April 2022. Among them, patients who received Bio prior to Jaki therapy underwent analysis of changes in CT images and serum KL-6/ SP-D levels in the same individuals. Change in CT images of pulmonary abnormalities, such as reticular pattern, was assessed by CT score: the extent of lesions of 6 lung fields was scored as follows; score 0 (absent), 1 (-25 %), 2 (25–50 %), and 3 (50 %-). The CT scan score for each patient was obtained by adding the score for each field (max 18). <h3>Results</h3> Patients included in the analysis were 79 RA patients, M/F; 34/45. When they started Bio, their mean age was 59.3 years old, disease duration was 7.7 years, positive for anti-CCP antibody in 82.9%, and positive for RF in 83.5%. They received 3.7 (average) different Bios for 4.6 years (average) prior to JAKi therapy for 2.8 years. Serum KL-6 levels increased by 91.2±416.0 U/ml (average+sd) during Bio treatment but decreased by 82.1±383.3 mg/dl during JAKi therapy. Similarly, serum SP-D levels increased by 10.1±60.3ng/ml during Bio but decreased by 23.7±83.1 ng/dl during JAKi therapy. However, no differences were found in KL-6/SP-D levels between periods with Bio and JAKi in the same individuals. ILD was found in 22 out of 79 RA patients. GGO was found in 2 cases. Reticular opacities were found in 18 cases, and 3 of them developed during Bio. Honey-combing occurred in 9 cases; 3 and 1 developed during Bio and JAKi, respectively. CT score of reticular opacities was increased in 9 cases (50%) during Bio but in 3 cases (16%) in JAKi (Figure 1) (p=0.04). The CT score change was significantly greater in the period with Bio than with JAKi in between-group comparisons and the same individuals (Figure 1). <h3>Conclusion</h3> The frequencies and severities of worsening in the CT imaging, particularly reticular opacities, were less in patients with JAKi than in Bio. JAKi did not worsen ILD but rather may stable it. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.